The cost-effectiveness of improved hepatitis C virus therapies in HIV/hepatitis C virus coinfected patients

Objectives:To evaluate the effectiveness and cost-effectiveness of strategies to treat hepatitis C virus (HCV) in HIV/HCV coinfected patients in the United States.Participants:Simulated cohort of HIV/HCV genotype 1 coinfected, noncirrhotic, HCV treatment-naive individuals enrolled in US HIV guideline-concordant care.Design/interventions:Monte Carlo simulation comparing five strategies: no treatment; dual therapy with pegylated-interferon (PEG) and ribavirin (RBV); PEG/RBV trial' in which all patients initiate dual therapy and switch to triple therapy upon failure; IL28B triage' in which patients initiate either dual therapy or triple therapy based on their IL28B allele type; and PEG/RBV and telaprevir (TPV) triple therapy. Sensitivity analyses varied efficacies and costs and included a scenario with interferon (IFN)-free therapy.Main measures:Sustained virologic response (SVR), life expectancy, discounted quality-adjusted life expectancy (QALE), lifetime medical costs, and incremental cost-effectiveness ratios (ICERs) in $/quality-adjusted life years (QALY) gained.Results:PEG/RBV trial,' IL28B triage,' and triple therapy' each provided 72% SVR and extended QALE compared with dual therapy' by 1.12, 1.14, and 1.15 QALY, respectively. The ICER of PEG/RBV trial' compared with dual therapy' was $37500/QALY. IL28B triage' and triple therapy' provided little benefit compared with PEG/RBV trial,' and both had ICERs exceeding $300000/QALY. In sensitivity analyses, IFN-free treatment attaining 90% SVR had an ICER less than $100000/QALY compared with PEG/RBV trial' when its cost was $109000 or less (125% of the cost of PEG/RBV/TVR).Conclusion:HCV protease inhibitors are most efficiently used in HIV/HCV coinfection after a trial of PEG/RBV, sparing protease inhibitors for those who attain rapid virologic response and SVR. The cost-effectiveness of IFN-free regimens for HIV/HCV coinfection will depend on the cost of these therapies. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins